What is Robotic Assisted Laparoscopic Prostatectomy?

A robotic assisted laparoscopic prostatectomy (RALP) is the removal of the entire prostate gland using advanced robot technology. The seminal vesicles and some of the pelvic lymph nodes may also be removed.

The Procedure

The procedure begins with the surgeon making five small incisions in the abdomen for the camera and robotic instruments. The abdomen is then filled with gas (carbon dioxide) separating the tissues to allow better vision during surgery.

The camera is passed through one of the incisions, followed by placement of the remaining surgical instruments under direct vision of the camera. Once the surgeon is satisfied with the port placement, he commences the operation remotely from the console located in the operating theatre.

The robotic system allows the surgeon’s hands to be translated into precise movements of micro-instruments while operating. It also gives the surgeon a 3D image of the operation, which helps to identify important anatomical structures. This 3D vision during surgery gives the surgeon the ability to preserve the nerves vital to erectile function and urinary continence.

Theatre staff are at your side throughout the entire surgery assisting with the procedure. The robotic system cannot be programmed, nor can it operate on its own. It can only make its movements on direct input from the surgeon.

Watch this short video of Urologist Jim Duthie to find out more about Robotic Assisted Laparoscopic Prostatectomy:

Recovery

After your robotic assisted laparoscopic prostatectomy, you can expect to spend only 1-2 nights in hospital. Patients are usually able to get out of bed the evening of the surgery and walk around comfortably the following day, so are at low risk of respiratory tract infections.

All patients will initially require a urinary catheter (a tube that runs up through the penis into the bladder). The primary reason for the catheter is to ensure healing of the connection between the bladder and the urethra in the proper anatomical position. (The tube will be removed after one to two weeks.)

Immediately following surgery almost every patient will experience temporary incontinence (loss of bladder control) and impotence (loss of erections).

As the surgical incisions are small and minimally invasive, they require minimal suturing and heal well, so the body can recover quickly and you can return to normal activities soon after with minimal need for strong pain relief.

However, all strenuous activity should be avoided for the first two weeks. You may feel physically tired for a number of weeks following surgery.

There are a few common side effects after RALP:

• Seeing blood in the urine is quite common for the first six weeks. However, excessive bleeding or burning when passing urine, or a frequent need to pass urine should be reported.

• Constipation may occur after RALP, but it’s important to avoid straining during a bowel movement as this puts pressure on the newly healing internal wounds. Your doctor will recommend an over-the-counter laxative to use for the first week or two.

The Risks of RALP

As with all surgery there are risks, and you will have the opportunity to discuss these with your surgeon and anaesthetist during the informed consent process.

These risks include:

Infection – any incision poses a risk of infection however this is minimised by administering antibiotics post operatively.

Bleeding – this is minimal during Open Prostatectomy and very rarely would a blood transfusion be needed.

Incontinence (loss of urine without control) – once the catheter is removed you may experience some incontinence particularly when coughing. You may need to wear pads in your underwear initially. The length of time this is required varies but, in most cases, is resolved within 4-6 months.

Impotence (loss of erections) – even if the nerves that control erections are preserved it is likely that there will be a degree of impotence. However in virtually all cases potency can be regained with the use of tablets, injection therapy, vacuum devices or implants.

In any laparoscopic surgery there is the risk that the surgeon will need to convert into an open procedure (larger incision). This happens rarely but maybe due to equipment failure, excessive bleeding or other complications.

If you’re interested in having a robotic assisted laparoscopic prostatectomy at Grace Hospital to treat your prostate cancer, contact your GP for a referral.